It is generally being recognized that some Arts in Medicine/Arts in healing organizational changes might be in order.

In short, Gainesville AIM is an infant profession that is experiencing growing pains. And thus it might be a good time to consider adopting some more permanent guiding ideology and organizational structure to make AIM more functional, responsive and appealing to a wider cross section of people for the long haul into the future.

This is a working paper and point of departure on the subject-- seeking ideas, perspectives, and consensus on the future of AIM. Thus, those AIMers, volunteers, fellow travelers, hangers on, camp followers, skeptics, etc., of all flavors and persuasions are invited to write your comments, expletives, suggestions, praise, etc., in the space provided or on a separate paper and return it to AIM.

The more of us who care to contribute in this way, the better we can all know where we collectively stand to build consensus-- which can thereby be translated into policy. We especially seek student volunteer input too! So please do contribute and get your two bits in!

Bob Allston, 11/18/98


The concept of a "niche" is a useful tool to analyze many different kinds of social, cultural, economic, and biological phenomena, particularly in their early or embryonic stages of development, as AIM currently is. For instance:

  1. When someone catches a cold, the cold germ will expand its territory throughout their body to the extent their body will allow it. In doing so, it is "filling its niche".

  2. The Internet was first limited to the universities and Department of Defense. Since then it has expanded rapidly spawning many new disciplines and businesses to fill a rapidly growing niche.

  3. When Darwin reached the Galapagos islands he examined the finches. The birds had originally come from South America and, once there, had evolved into several distinct species, each of which took advantage of different food supplies, largely through different shaped beaks. Each of these species of finches had thus evolved and expanded its population to fill its separate niche in the islands, defined to a large extent by the available food supply.

  4. The Anglican church split off from the Catholic church due to social and economic dynamics during the reign of Henry VIII. The Methodist church split off from the Anglican church around 1750 because the Anglican church wasn't filling the niche of administering to the poor. Then the Salvation Army split off from the Methodist church (with currently around 20,000 locations worldwide) around 1865 because the Methodist church wasn't administering to the poor.

  5. An examination of many social, civic, professional and labor organizations demonstrates similar dynamics.

From these little examples we might make a few general observations on the nature of niches:

  1. If you don't fill it, somebody else may. For, a niche is by definition, a space that invites filling.

  2. It is often very difficult to know the boundaries of your niche. Neither the cold germ, the originators of the Internet, the finches that first arrived in the Galapagos, Henry VIII, John Wesley, or William Booth, had any idea of what the boundaries of their niche was when they started out. And finding the boundaries is primarily a process of trial and error.

  3. As the biological/economic/sociological process of filling the niche proceeds, it becomes increasingly pluralistic.

  4. As the process becomes increasingly pluralistic "control" or "leadership" transfers from the original "founders" (cold germ, Bill Gates, flock of finches, Henry VIII, John Wesley or William Both) to new elements.

  5. These new elements of control are self perpetuating; thus continuing the process of filling their niche beyond the founders into the indefinite future.

  6. As this process matures, organisms in the biological world, and organizations/movements in the economic/cultural world often subdivide into multiple specialized entities in order to fill related niches. In the biological world it is the process of forming a new species and in the economic/cultural world it is often termed a spin off, splinter group, etc. In both biology and economics/culture, this process is considered healthy, normal, and it is a leading source of beneficial change.

What do you think?


I would say the core of AIM is the (1), bedside patient relationship which is typically (but not always) augmented by (2), art of various kinds.

The scope of bedside patient relationships would include:

  1. All bedside patient relationships in the hospital room setting; as well as performances in such places as Charlie's Corner and the Atrium at Shands Hospital. I am also of course including the bedside relationship in the Arts in Healing program at Alachua General Hospital and similar performances there.

  2. We also include such things as the bedside-patient relationships of doctors, psychiatrists, nurses, art therapists, etc., (and whether or not paid for their services). I know this appears to be somewhat broader than we generally think of our mission, but if we don't, it leads to confusion. For, a doctor, nurse, psychiatrist or art therapist may join AIM and thus visit a patient through her/his capacity as a member or volunteer with AIM or s/he may do exactly the same thing through her/his own established professional channels.

  3. The term would also include AIM member relationships with prisoners, nursing home residents, school children, institutionalized psychiatric residents, etc.

It strikes me that the bedside patient relationship can be referred to as either an art or a science in popular usage. Thus "the art of human relations" or "the science of human relations".

However, the principle discipline that studies the bedside patient relationship is probably psychology which is a social science. And, as discussed further along, we overlap substantially with the disciplines of art therapy and music therapy both of which make psychology an integral part of their disciplines.

As to the second part, art, we have any number of professions in the arts represented-- painting, dance, poetry, music, etc. Here again, especially in this academic and research setting, we are not just talking about "art", either. For many of these arts are studied and understood through various social sciences as well; such as the psychological or anthropological perspectives of toning or playback theater. Indeed the anthropological research on all art forms, across numerous cultures, probably fills many fascinating volumes and would provide us with invaluable perspectives on how to employ them.

We are in the exclusive domain of science when we go to prove or demonstrate the effectiveness of the various modalities of healing that we employ.

Thus, our ideological character is a closely woven fabric of both the arts and sciences.

However, there is of course another side to our character as well. Many would spurn such intellectualization and refer to the bedside patient relationship as simply the love of one human for another. Many would cite religious perspectives.

Thus we are in fact very multifaceted, multidisciplinary and pluralistic in every sense of the word.

What do you think?


With these things in mind, we can make a few generalization's about AIM's niche. First, it is of course worldwide. It also has many players besides us in many hospitals around the world vying to fill it. It also tends to be geographically segmented-- separate groups in each area. For our part, our organizational structure is almost entirely limited to Gainesville.

Thus, AIM's niche is vastly different in each local area. In an undistinguished small town hospital it will be vastly more limited in scope than it is in Gainesville.

In Gainesville, we are arguably in the state's top teaching and research hospital surrounded by the state's top university and our niche therefore necessarily includes much of this territory. We also arguably have a moral responsibility to the movement to expand into this academic and research area, for it can vastly enrich and advance the movement for all, including those locations that don't have such facilities.

To establish that AIM has its own niche, it is sufficient to demonstrate that:

  1. AIM makes a worthwhile contribution to society. (For if it doesn't, it has of course, no justification for its existence.)

  2. this contribution is not better accomplished by one or more other established professions. (For if it is, we might as well forget about AIM and join the other professions.)

I think the first part of this issue could be established in many ways. Perhaps one that is as good as any is to view our social/economic contribution as a two part process. First, it is well established of course that art has a positive effect on the mind, and secondly, it is being increasingly established that the mind has a positive effect on both mental and physical health phenomena across a broad spectrum of mental/physical health areas (such as for instance depression and immune response.)

To examine the second part of the issue we must examine other professions that appear to be the closest in function to what we do. There are of course many professions in both the arts and sciences that overlap in function to some extent to what we do. Thus in the arts we have such things as painting, music, dance, and in the social sciences such things as psychology, sociology, anthropology, etc. We have as well the professions that are designated as therapies such as art therapy, music therapy, occupational therapy, physical therapy, recreational therapy, etc.

Out of these I would imagine the ones that are the closest to what we do are art therapy and music therapy.

The mission statement of The American Art Therapy Association states:

  1. The American Art Therapy Association is an organization of professionals dedicated to the belief that the creative process involved in the making of art is healing and life enhancing.

One art therapist, Vicki Barber, describes art therapy thus:

  1. At some point in their lives, people may find themselves overwhelmed by the intensity of their emotions which are difficult to face either by themselves or with others. Art therapy offers an opportunity to explore these intense or painful thoughts and feelings in a supportive environment. It involves using a wide variety of art materials, for example paints, clay, batik, to create a visual representation of thought and feelings. Art therapy can be an individual activity but is often used very successfully in group situations.

  2. Art therapy requires no artistic ability. The art therapist offers guidance and support and the opportunity to explore issues of concern using a variety of art materials.

  3. It is also for people who feel they are problem free but would like the opportunity to explore issues within themselves.

How people who have tried art therapy view it:

  1. It's not about being an artist, it's about using visual symbols to explore feeling and emotions.... it's about seeing feelings, making them visible to yourself.

  2. There's a beauty that is free to grow, an expression that can be extended, a space that is fun, safe and good to be in, that's art therapy.

  3. It is the process that is important, not the product.

  4. I'm interested to see how my mind works-- that part of my mind I'm not conscious of.

The American Music Therapy Association states:

  1. Music therapists assess emotional well-being, physical health, social functioning, communication abilities, and cognitive skills through musical responses. Design music sessions for individuals and groups based on client needs using music improvisation, receptive music listening, song writing, lyric discussion, music and imagery, music performance, and learning through music. Participate in interdisciplinary treatment planning, ongoing evaluation and follow up.

  2. Children, adolescents, adults, and the elderly with mental health needs, developmental and learning disabilities, Alzheimer's disease and other aging related conditions, substance abuse problems, brain injuries, physical disabilities, and acute and chronic pain, including mother's labor can benefit from music therapy.

  3. Healthy individuals can use music for stress reduction via active music making, such as drumming, as well as passive listening for relaxation. Music is often a vital support for physical exercise. Music therapy assisted labor and delivery may also be included in this category since pregnancy is regarded as a normal part of women's life cycles.

  4. Clients need not have any musical ability to benefit from music therapy nor is any particular style of music more therapeutic than others.

Clearly there is much overlapping in what we do and what music and art therapy do. However, we are in a different niche than they are by virtue of the fact that many AIM people function as unpaid volunteers and most people with art or music therapy degrees are probably salaried.

This poses some questions as well. Since they have university degrees, can they do it better? If so, should we grant university degrees also? And if AIM begins granting university degrees, will we be in effect educating ourselves into their niche? Does it matter?

There are other volunteers at Shands, and possibly Alachua General Hospital, as well, that have bedside relationships with patients. We thus overlap with what they do in the hospital as well.

There is a tendency in all organizations to prefer to employ people from the profession that most closely fits management's professional, economic and cultural objectives. For economic reasons, if nothing else, they will also tend to narrow the number of professions they deal with when they have a choice of people from professions with similar abilities.

Thus AIM would be wise to continually examine its niche from many perspectives, centering it as much as possible within areas not administered to by other professions. For clearly we make the greatest social/economic/cultural contribution functioning within our own unique space.

As well, we should always strive to "be all we can be" regardless of how competent or unique we see ourselves; for it's a dynamic shifting world out there where change is the only constant. The fact is that many if not most social/economic/cultural movements that rise rapidly disappear or are overtaken by others just as rapidly.

What do you think?


Having defined the function and scope of AIM, we can now turn to the issue of an organizational structure that best accommodates it. For, as an infant profession, AIM needs to have an organizational structure that will allow it to best fill and administer to its niche.

And, to do this, it needs an organizational structure that will allow it to meaningfully process all issues that come before it, both from without and from within, in a reasonable time frame.

Generally speaking, pluralistic democratic structures, such as organizations employing "Robert's Rules of Order" and related structures, are the norm in our society for this purpose. Adopting such structures (where otherwise appropriate) holds the following advantages for AIM:

  1. Such structures furnish an established and proven platform from which civic/professional and non-profit organizations of all varieties explore and grow into their niche. Thus, they provide a platform for funding, membership drives, new projects, decision making, committees, etc. Establishing a healthy functional democratic and pluralistic structure for AIM now will be invaluable in allowing AIM to explore and expand into the uncharted waters of the future, ultimately beyond the life of its founders in the event either of them should become incapacitated or die for any reason.

  2. There are no ideological impediments to AIM adopting such structures; so nothing in our ideology would need to change.

  3. When looking for an organization to join, members of the public often feel more comfortable with such familiar structures and are attracted to them. Thus for instance, people may be more attracted to volunteering or working with AIM if they can participate through voting on issues of concern to them.

  4. Since such structures are the norm in our society, new members familiar with such structures (volunteer or salaried) would not need so much time to get up to speed and be productive.

  5. Pluralistic membership as to profession, race, gender, education, interests, etc., is insurance against many problems. Thus if we have a retired CPA as a volunteer, he might defend us against accusations of misuse of grant funds. If there are nearly the same number of men and women in AIM, we are less likely to be negatively stereotyped as a "men's organization" or a "women's organization".

What do you think?


Having covered AIM's function and organizational structure, we are presented with the universal economic question-- how do we best employ these limited resources to achieve our goals. That is, how do we employ our people, organizational structure, modalities of healing, funding, host institution support, etc., to best achieve our goals? More technically speaking, given our limited resources what do we wish to optimize? Smiles? Healing disease?

Suppose we have a group of volunteers each of which has the talent to contribute three different kinds of dance and three different kinds of art for a total of six different modalities of healing; and they want to contribute in a manner that will do the most good.

How do we select which of these modalities of healing is given to which patients? Do we just ignore the issue and do it as chance dictates? Do we look for the best smile we can produce? Do we look to lower their blood pressure? Do we try to help cure whatever disease they may have?

Or, do we do comparative clinical evaluations to learn which of our modalities of healing is the most effective? Then based on the results of the clinical evaluations do we do patient evaluations so we can better advise each patient what modality of healing art might be the most effective for each patient?

Such clinical or patient evaluations can of course be very simple taking only a few minutes for a few questions, or highly complex, involving any number of medical diagnostic procedures, psychological evaluations, etc. How do we determine which to use?

When we are applying for grant funds, should we tell granting institutions we intend to apply the funds to the best cost/benefit modalities of healing? If so, what is our criteria for determining the cost/benefit of our various healing modalities so we will know which modalities are the most cost effective?

Should we just ignore all of these issues outside of a few more or less subjective observations?

Suppose we could substantially increase our effectiveness, perhaps double it, by examining such issues. Do we have a moral obligation of any kind to the public, our financial supporters, ourselves, our volunteers, our host institutions, etc., to do the most we can with our limited resources?

What do you think?


Central to solving the economic issues discussed above, is the matter of establishing the effectiveness of the various modalities of art we employ.

One characteristic of a research hospital is that it commonly does research to determine the effectiveness of various modalities of healing. Any medical researcher who proposes a new modality of healing must submit his modality to rigorous scientific tests of its effectiveness.

Not only are such examinations appropriate and necessary for AIM's long term health and survival but we don't want to leave the impression that we consider ourselves somehow above it or that for some reason it doesn't apply to us; for there is no question it does.

When an artist submits her/his painting to an art show, the judges make their evaluations of the comparative merits of the various art objects submitted. Judging art is of course highly subjective and subject to "mankind's frailties", such as biases and prejudices as well as being subject to which artists "know the judge". If the winning artist is lucky, the media will carry the story increasing the artist's exposure.

Clinical examinations are merely the health profession's version of an art show. However the criteria used by the judges in a public art show is of limited value to the health professions because they must employ their own criteria to measure the value of the art-- blood test results, heart rate, blood pressure, clinical remission, weight gain or loss, etc.

In other words the art must be evaluated in medically meaningful terms just as the judges in the art show must judge the art by their more or less established standards. Unfortunately of course, the judges in the medical world are subject to mankind's same frailties. However, arguably, they can be more objective due to the fact that their evaluations are for the most part based on less subjective more quantifiable criteria.

In the case of an art show, the artist can attempt to modify her/his art to meet the current demand/interests of the judges and public or s/he can take the "purists" view; refusing to bend to such demand. I would think the same principle applies to art evaluations by the health professions.

There is however a moral component to the issue. Are we creating art for art's sake or are we creating art specifically for the purpose of healing? If it is the latter then we should seek and pay attention to the results of the clinical evaluations, changing our art accordingly, both as to the effectiveness of one modality of art compared to another and within the same modality.

Of course, where we overlap with such professions as art therapy, music therapy, art education, music education, etc., we can borrow on their experience.

Indeed, if we feel we can beat out the drug companies on curing depression, for instance, I would think we have virtually a moral responsibility to prove it. Seeking to prove our effectiveness across a wide range of healing modalities is an area that is at the very core of our niche in a research hospital setting.

And, it strikes me that until such a serious effort is made, both the medical profession and public will be prone to view us at best as a nice but optional presence in hospitals and other host organizations. However, once such an effort has been made with significant published results, we have at least the possibility of being viewed as a more integral and necessary part of hospital, if not medical, practice and organization, nationwide if not worldwide.

AIM, worldwide, is part of a holistic movement which is eager to demonstrate its effectiveness. One of the principle problems of demonstrating scientifically the effectiveness of holistic modalities in the past has been the difficulty of dealing scientifically with the great quantity and variation in the data such studies tend to demand.

At the same time, the history of science is one of ever expanding capability in this regard. Thus there is a convergence of public demand placing pressure on the scientific community, new mathematical techniques, etc., which will inevitably lead to significant expansion in the scientific examination of the entire holistic health area, for the benefit of all.

AIM is in research hospitals worldwide and it is thus inevitable that it will be part and parcel of this process. If we attempt to stay out of it, we will find ourselves going to professional meetings and reading professional journal articles where other AIM organizations are forging ahead.

Also of course, there is much overlap in what we do and the art therapy, music therapy, and other professions for which such procedures are an integral part. Indeed, psychology, with its scientific methods, is a core component of these two particular professions.

The bottom line is that such studies are an integral part of AIM.

If all this seems to be too much of a rat race, it would appear to me to be no more or less so than the rat race that most successful artists must subject themselves to anyway. For, most successful artists follow and submit their works to art shows to get the exposure and build name recognition.

As well, such procedures are, as in medicine, a principle means of gaining publicity in medical and other journals; which in turn brings both credibility and funding from the medical community, foundations, and the public sector.

Also, such research carried out at an established major research facility, such as Shands, carries far more weight and credibility, than if carried out in a non research hospital. Indeed, we are very privileged to be in such a setting and hopefully at some point we will have the opportunity to prove to the world the value of what we do.

What do you think?


In previous sections, we examined how we can apply economic analysis and clinical examinations to improve our effectiveness. In this section I want to examine a simpler but nevertheless useful method of examining our effectiveness.

Here, I want to pose the question of how well we meet our patient's needs across all our modalities-- music, visual art, dance, etc.; although I am limiting this discussion to the example of music, since I know it a little better.

Classical music ranges over a thousand years or more, taking the form of medieval church music, madrigals, symphonic, grand opera, comic opera, operetta, classical, romantic, impressionist, contemporary, lieder, chamber, chromatic, tonal, major-minor, etc.

Most musicologists would agree that it is a much richer, more varied and more complex genre than what is generally described as contemporary music.

However, the other day, I counted the tapes in the AIM tape inventory, finding around 280 contemporary titles and around 20, or seven percent of the titles were classical titles. Most of the most commonly performed symphonies, operas, chamber music, vocal music, etc., were not available. There were, for instance, probably far more tapes on one contemporary form of music, such as jazz, than all of the classical forms put together. (To save time, the only tapes counted were those where the labels were visible without having to take them out of their slot).

In our Charlie's Corner performances, I don't recollect any classical music being performed. We have performed it in the Atrium, but it has been largely limited to piano and I don't ever recollect hearing any classical vocal music of any kind anywhere, although of course there may have been some that I missed.

While playing in the Atrium, I virtually always invite passers-by to play should they care to. Here I have found what appears to be a strong bias toward the classical genre among doctors, residents, scientists and science students in general. Although the tastes of others around the Atrium is less clear there is no lack of people who like classical in this population as well.

Of course, I admit to preferring classical myself, but I still think it is reasonable to suggest that classical music is vastly underrepresented as to meeting our patient's needs and preferences.

This poses the question, as mentioned above, as to what extent we are matching the needs of our patients, across the board, in all our art modalities, such as music, visual art, dance, etc. I personally don't have much of a feel for this, outside of music, having no background in these areas, but I'm sure others of us do.

If, for instance, we could double our effectiveness through attention to this area, should we do it?

Here again, I would also assume that people in art therapy, music therapy and art and music education, among other professions, could be invaluable in giving us a handle on the subject as well.

What do you think?


For every function that we do, there is an associated procedure. It may be inconsequential or it may be important.

A few that may be worth looking at:

  1. When one of us makes contact with a potential volunteer, it might be nice to establish a "user friendly " minimum hassle procedure to further introduce her/him to AIM and the various ways they might fit in as a volunteer. This might take the form of a once or twice a week scheduled orientation by various present volunteers or staff, or something else. Many times I have gotten into chats with people at the Atrium piano, and taken them up to the fourth floor hoping to be able to introduce them around a bit but there isn't anyone there. Of course, when there is someone, they are always very gracious and accommodating. However it can also be time consuming for the staff or volunteer if they happen to be cramped for time, which is of course not unusual. I find that the vast majority of people that I have chats with, and who display what appears to be a genuine interest in volunteering, never appear to materialize as volunteers; although I wouldn't attach much significance to that fact alone. If they are interested in musical performance, they need to contact Cathy DeWitt to be checked out which is of course good procedure. However they will sometimes stop by while I'm playing sometime in the future and say they can't find Cathy or they are otherwise confused about some minor issue which they have been unable to resolve. The short of it is of course that the first impressions we make to potential volunteers is very important and the area might be worth examining toward a more systematic solution regarding all such first contacts between staff and volunteers, and potential volunteers.

  2. I get the impression from various sources that our student volunteers and potential student volunteers are not always getting the attention and direction they need when they come over from campus. It is of course a substantial trek over here from campus. If you come by car there is a parking problem. If you come by bike there is the campus' biggest hill virtually requiring a long tedious walk back up the hill on the return trip. If you walk, it is a long walk. Any busy student who should come over by whatever means is not going to be a happy camper if they meet confusion or can't otherwise accomplish their purpose on this end. Just how serious the problem is or what the solution might be, I don't know but perhaps the issue is worth exploring.

These few issues only touch on the subject of procedural issues that might be beneficially addressed. Some of them have been touched on in other sections of this paper, and perhaps other staff or volunteers would like to contribute on the subject.

What do you think?


I don't know the extent of our volunteer enlistment efforts, but perhaps we could think in terms of an organized effort in this area. That is, having a look at our volunteer requirements in various areas-- art, dance, music, the areas mentioned below, etc., and utilizing our present volunteers with staff support in an organized effort to enlist more volunteers. Perhaps, for instance, some of our student volunteers, as part of their volunteer effort, would be willing to contact faculty, student organizations, etc., to enlist more volunteers.

The second issue I want to raise in this area is that there appears to be the general perception that the best, if not only employment for volunteers, is in the area of bedside support. Bedside support is of course the reason for the existence for AIM, and I wouldn't question that the principle thrust of our efforts to obtain volunteers should be in that area.

There is however a wealth of knowledge and skills available to us at the University and community outside of this area that would be very useful. Making an effort to enlist these skills has a three fold benefit for us. First, we obtain the skill. Secondly, we establish contacts and get exposure around the campus and community. Third, whether or not they care to volunteer in their area of academic expertise, they might like to volunteer as a bedside volunteer. For instance:

  1. There might be faculty or students in the Business School or related academic areas who would take an interest in helping us with organizational structure.

  2. There are social/educational/economic issues that various academics or their students might be willing to lend a hand with. These would include complex issues about the long term implications of using unpaid relatively untrained volunteers v. the use of professional people with degrees. They would include such issues as how we deal over the long term with related disciplines such as art therapy, music therapy, art education and music education, etc., as discussed in the section above. Do we incorporate their educational requirements into our own? Do we depend on their studies or information otherwise on the effectiveness of what they do or do we do our own studies? Do we make an active effort to enlist them as volunteers or staff? Do we concentrate our efforts on areas that don't overlap with what they do or do overlap?

  3. Various academics might be willing to lend a hand and their prestige with arguments supporting grant requests.

This doesn't scratch the surface in this area, nor do I suggest everything I've mentioned is of value, but perhaps it gives an idea of something that might be worth looking into.

What do you think?


This section deals with our cultural character and plurality, and thus ability to appeal to those in various walks of life.

As I understand it, rounds meetings were originally specifically designed to discuss solely volunteer-patient relationships; being modeled after meetings of the same name and similar function operated by doctors at Shands. The meetings were and still are most often chaired by one or both of the AIM founders.

To my knowledge, rounds meetings are the only regularly scheduled forum for Shands AIMers to discuss issues of any kind. Thus I assume there was and is no other established forum for discussing and resolving issues outside of patient relationships although I'm not quite sure how Tina Mullen and CAHRE fit into the picture.

This kind of rounds structure is appealing in its simplicity and it promotes close ties between the regularly attending artists and the founders. I think it may also lend itself to the nature of art as an intensely personal thing, reminiscent of the close ties that developed for instance among many of the French impressionists.

However the down side is that it apparently leaves no scheduled forum for discussing anything other than bedside relationships. I assume this fact forces the myriad of other issues to go through the founders or others through unscheduled and "unofficial" channels.

The short of it for an organization like AIM is that such a process inevitably breeds a world of favoritism, insiders and outsiders. Equally seriously however, it tends to attract only those with personal and cultural characteristics similar to the persons furnishing the access; all necessarily constituting a rather narrow closed social group as opposed to a more pluralistic professional group, which, as stated previously, better fits AIM's requirements.

The lack of any pluralistic voting mechanism in the rounds meetings accentuates these same characteristics as well.

The upshot is that the rounds meetings, as AIM's only scheduled forum, resemble somewhat an "artsy woman's" "club" in character in which those people who don't fit the mold have fallen by the wayside and those remaining fit the social/cultural mold of the founders and have no problem with access. Thus it is a rather closely knit group of 10 or so regular women attendees with very similar social/cultural/ethnic/racial characteristics. All of the women probably have artistic abilities as well, although, asset forth above, such abilities aren't necessary for AIM.

The narrow social/cultural/ethnic/racial/gender characteristics of the group would appear to be defacto evidence of its exclusionary characteristics. However I think one can identify a number of specific characteristics that operate to exclude specific groups:

  1. The perception that it is necessary to be an "artist" of some kind to be a valuable or productive member of AIM. As discussed above, this is not the case but the perception operates to exclude many who would otherwise be interested.

  2. Because the group is almost entirely made up of "arts culture" as opposed to "science culture" people (such as discussed in the Cambridge lecture entitled The Two Cultures by C. P. Snow) it operates to exclude "science culture" types. Some characteristics of "Art culture" people that make the group less attractive to "science culture" types would include (1), non-scientific belief structures such as astrology (2), lack of interest in submitting art modalities to scientific studies of their effectiveness (3), lack of understanding or interest in the Web (4), little knowledge or interest in science (5), distrust of science (6), The perception that science is "male" in character and culture (7), negatively stereotyping of the art therapy and possibly other professions (8), the perception that "science culture" types will be closed minded or negative toward some art forms (9), The use of words that have specific scientific definitions in unscientific contexts such as "energy from the universe", "vibrations", etc. (10), the belief that AIM should be a "women's organization" (11), the belief that employing a "Robert's Rules" organizational structure would open the door to male domination of AIM.

As to the second point above, although I suspect for the most part that each of these views is carried by probably only one or a few AIMers, since the group is small, the social/cultural effect is noticeable, diminishing AIM's attractiveness to those in the sciences in general and other groups as well.

Also of course, this is a cultural analysis, not any kind of moral observation. As far as I'm concerned, it's certainly fine for any AIMer to like astrology. Also it isn't any observation that being an artist is negative in any way. If AIM rounds consisted of nothing but a room full of mathematicians AIM would probably attract far fewer people than it does now; but it wouldn't be because there is anything wrong with mathematicians.

Although there are about 700 doctors at Shands, there are no doctors or nurses that regularly attend rounds meetings, outside of AIM's founders. Also, in recent funding drives, hundreds of doctors have been contacted and they have contributed almost nothing. These facts suggest the possibility that AIM's image does not optimally appeal to the medical community as well.

One thing I have noticed from the wonderful Thursday lectures on alternative medicine, is that the actual merits of the various so called "alternative medicines" such as acupuncture, herbal remedies, etc., have been subject to stereotyping and prejudice to such an extent that objective studies of their effectiveness are either not being done or they are being lost or suppressed. Although the situation is improving, these disciplines are still in limbo to a large extent as to their status and effectiveness. I fear that AIM may suffer the same fate if it doesn't take strong steps to integrate itself into the scientific community of which I view it to be already an integral part; ideologically, if not otherwise.

At the same time, I see no down side to the issue. I don't see that working more closely with the medical profession in any way reduces our independence as to our art or anything else. To the contrary, it could bring us more assistance, funding, etc.

Thus, AIM could seek studies of its healing modalities it believes to be effective. It could take active measures to solicit rounds attendance from the medical-scientific community. We could solicit membership from the art therapy and music therapy professions, probably in fact our closest ideological partners, and from whom we could learn a great deal. Being an integral combination of art and science, we could examine the belief structures of art and science and develop our own ideology of combined art and science to promote mutual understanding and common purpose.

If AIM had another general purpose forum, where all subjects of interest to members could be addressed, preferably "Robert's Rules" based, I would think this change alone would go a long way to pluralize its image in a way to make it more attractive to a wider public.

This section doesn't discuss all the complex issues on the subject, nor do I believe I have it all right, but hopefully it is a start.

What do you think?


As discussed above, the short of it is that AIM is simply far too broad and pluralistic to be accommodated through a single forum, such as rounds in its present form, addressing only a single issue (bedside relationships), to the exclusion of all others.

Thus I would opt for a more pluralistic democratic forum, such as a Robert's Rules structure, or some modification of it, even if we still wish to set aside a meeting limited to discussing only bedside patient encounters as I gather rounds has been traditionally employed.

As to the question of whether other issues should be taken up at rounds meetings, it seems to me it is of no particular importance provided sufficient time in a democratic pluralistic forum of some kind is available to discuss the many other important issues.

Another alternative approach to current rounds meetings would be to have separate rounds meetings for different fairly homogeneous groups such as for retirees, students, scientists, etc., as opposed to having just the one group. Also the one group might be broken into sections of some kind to accomplish the same purpose of appealing to different groups and cultures. Another possibility is that once weekly or monthly meetings with broader subject matter are established, many might prefer to attend them and thus rounds meetings would no longer be the major forum, and thus the major focus, for AIM.

What do you think?


In this section I am just enumerating a few of the more important areas that could use some attention:

  1. Expansion into local jails/prisons.
  2. Expansion into local nursing homes.
  3. Expansion into local schools.
  4. Designing and implementing a Web presence.
  5. Designing and implementing a membership drive.
  6. Designing and implementing a funding campaign.
  7. Protecting member's artistic rights.
  8. Providing adequate support of student volunteers.
  9. Self examination of our cultural biases.
  10. Designing and implementing studies of our effectiveness.

What do you think?


As AIM grows, it would appear that a professional organization that is independent from any host organization is at some point inevitable; for virtually all professions have such organizations.

For there are issues necessary to the growth and development of AIM that are best addressed in such an organization, or that only such an organization can address.

Such an organization must be able to expand and contract with the demands upon it and accommodate growth into new areas.

Thus it is a necessary component in facilitating the natural growth of AIM within both its local and worldwide niche, and in our leadership role in the AIM movement it is simply one of the more important AIM institutions to be set up, made operational, and gain experience with, so we can intelligently advise others and possibly offer local chapters around the country. There is also the possibility of course that we might prefer to apply to become a local chapter of an existing professional organization.

A partial list of issues for a professional organization would include:

  1. Seeking United Way funding for the organization
  2. Seeking Grants for the organization
  3. Maintaining a Web site
  4. Communicating our experiences with other professional organizations
  5. Facilitating and promoting education for our members
  6. Sponsoring professional meetings
  7. Promulgating professional ethical standards
  8. Protecting our member's artistic rights
  9. Promoting our profession.
  10. Conducting membership drives
  11. Maintaining a student section for issues of interest to students
  12. Making bulk purchases of art materials and other items
  13. Negotiating discounts for art materials and other items
  14. Furnishing various kinds of insurance for our members
  15. Researching and pursuing legal issues of interest to members
  16. Negotiating with host organizations such as hospitals, jails, prisons, nursing homes, the VA, etc., about working conditions, safety, legal liability, visiting hours, support, parking space, purchasing needed musical instruments, needed art materials, working space, furniture, computers, sales kiosks, etc.

What do you think?


This center has been recently established. Research and education is of course very vital to AIM but I am not involved with CAHRE, so I'm not familiar with what it is doing. There is presently a credit course being taught in dance in medicine and I'm sure other courses are planned.

What do you think?


No matter what form our own organizational structure might take, issues will need to be taken before any host institution in which we function, such as Shands or AGH.

Recently, three volunteers including myself were discussing the matter and we decided we didn't know whether we even had the right to complain about anything let alone how it might be accomplished.

Standard organizational theory suggests there should be a well defined route from the first level to the top level of management through which to take matters of interest to AIM staff, volunteers, etc. should they wish to do so.

Progressive organizations pride themselves in having an "open door policy" wherein issues can be taken up through successive levels of management to the top and the "appellant" is guaranteed there will be no reprisals against her/him for doing so. They don't always function this way but it is a goal well worth shooting for and possibly it is operational in some areas of Shands and AGH now.

I would opt for a structure in which it is established as a matter of policy that all AIM staff and volunteers operating under host organization management are explicitly given the right to (1), address any issue of interest to them on a first level and if this doesn't result in a satisfactory resolution, to (2), "appeal" the issue through successive levels of management to the top if they care to, (3), they know the organizational path through which to take the issue and (4), they are guaranteed they will not be injured in any way for doing so and (5), they may request and obtain confidentiality should they wish.

I think it is rare that AIM volunteers or employees would avail themselves of it but the fact of its existence is a source of comfort to people, it indicates progressive and thoughtful management policy, and in cases where it is availed of it can potentially be of great value to the "petitioner", AIM, the host organization and everyone concerned.

Thus for instance, it might be employed for anything from a request for a free parking slot in a garage to reporting medical malpractice or reporting who might have stolen hospital or AIM equipment.

Although I don't think such an avowed policy would be of great importance to student volunteers; on the margin it couldn't help but be a plus to recruiting them.

Also it functions as a valuable feedback mechanism so we can monitor what is going on with the volunteers. If for instance the policy encouraged a volunteer to report the fact that s/he wasn't getting sufficient direction and support, or to raise the issue of sexual harassment or perhaps prejudicial treatment, it would be far superior to just having the volunteer stop volunteering without AIM knowing why.

There is another principle of management that specifies that responsibility should be commensurate with authority through each management level. In other words, regarding anything a manager has authority over, s/he is held responsible for furnishing the support necessary to get the job done. I propose the principle be adopted as standard modus operandi.

Thus any ambiguities in the authority over AIM and AIM projects between CAHRE, Tina Mullen, the founders, or others would be resolved and the entity claiming authority over any particular AIM person or project would accept responsibility for furnishing the support necessary to get the job done.

Thus we would know who to go to on any particular project and our manager could in turn take the matter further up the ladder under the same principle if s/he needed to. This fits in with the above open door policy also, for, in both cases, an unambiguous chain of management is established.

Of course projects that are managed by AIM rather than the hospital would establish a path of appeal through AIM. In some cases, it might be appropriate to take issues up through the hospital first then to AIM, or to AIM first then to the hospital depending on the chain of project management structure between AIM and the host organization.

What do you think?


At this point, we have covered a lot of issues. Hopefully the paper has stimulated some thought about how each of us, employing our individual talents and interests, may help build consensus and contribute on into the future.

To do this in turn, we must be able to intelligently address the ultimate issue. The issue of issues: we must be able to intelligently address all issues that come before AIM, from without or within, in a reasonable time frame.

So lets take stock of what existing capacity we already have to do this:

  1. We are fortunate to have the CAHRE center in place. It can address issues of research and education, among other things.

  2. We have organizations at Shands and AGH. They can address many issues; but between them and CAHRE, there are many issues remaining.

To address all remaining issues, I think we need to consider constructing or modifying three different kinds of organization/forum:

  1. A forum to discuss bedside relationships which of course we already have.

  2. A forum to discuss issues that fall within the auspices of our host organizations (Shands, AGH) but outside of bedside relationships. This we don't currently have.

  3. A forum to address issues that fall outside of the scope of the auspices of our host organizations or CAHRE. This is the professional organization discussed in a previous section. This of course we don't currently have either.

There is of course considerable space for overlapping and some of the remaining issues could be raised in two or even all three of these categories. Also, the forum to discuss bedside relationships could probably be included within either the second or third, or both of the latter two forums, making a total of only two types of forums actually necessary.

For an example of how we would assign various issues to these different forums, suppose we want to get parking stickers for parking at Shands. Obviously we aren't going to bother CAHRE with it. However we might like to bring it up at a Shands sponsored meeting (the second type of forum above) or through Shands channels otherwise. Perhaps if that didn't get results we might try to negotiate the matter through our professional organization (the third type of forum above).

For another example, suppose one of us has a job at Shands but has to leave the job for a while for medical reasons. Suppose Shands says that if you leave they will terminate the job. This issue might be brought up at a Shands sponsored meeting or through Shands channels otherwise but if it fails it could be brought to our professional organization for negotiation with Shands.

If we wanted to request United Way funding or other grant funding for our professional organization, that would of course only go through the professional organization.

I would think there would be a considerable advantage in an integrated approach, considering all this at one time (although it probably couldn't all be done at the same time). That is, considering what subjects/issues CAHRE and our present organizations at Shands and AGH, can now handle, and how we need to add/modify the three forums above in such a manner that all issues we can think of and hopefully all potential subjects/issues could be intelligently addressed in one forum or another, in a timely manner.

A substantial part of this would of course be designing the bylaws for our professional organization. Possibly of course we might just prefer to join an already existing professional organization, making this a local chapter.

What do you think?

This is a page in the Web site entitled Mainstreaming Arts in Medicine.

Copyright © 1999, Robert Allston. All rights reserved.